Heart Rate Variability Training Research Articles

ALIVE Biofeedback HRV training for Treating Insomnia: A Pilot Randomized Controlled Study.

Background: Insomnia is a common sleep disorder that affects a large portion of the population. While several treatments are available, such as medication and cognitive-behavioral therapy, some individuals may not respond well to these treatments. Biofeedback, a technique that provides individuals with real-time feedback on their physiological responses, has shown promise in treating insomnia. This study aimed to investigate the effectiveness of ALIVE biofeedback HRV training in treating insomnia. Methodology: This pilot study utilized a randomized controlled trial design to investigate the efficacy of ALIVE biofeedback intervention in individuals diagnosed with insomnia. A total of 60 participants with insomnia were randomly assigned to either the ALIVE biofeedback or control group. The ALIVE biofeedback group received a six week intervention involving relaxation techniques, deep breathing exercises, and mindfulness meditation using the ALIVE Pioneer system for heart rate variability (HRV) biofeedback training. The control group received standard care for insomnia. Outcome measures included HRV parameters, blood pressure, the Pittsburgh Sleep Quality Index Japanese version (PSQI J), and the Insomnia Severity Index (ISI). Results: The ALIVE biofeedback group showed significant improvements in heart rate variability (HRV) parameters, including increased SDNN and RMSSD and high-frequency power (HF) after the 6-week intervention. The control group did not display significant changes in HRV. Additionally, the ALIVE biofeedback group significantly decreased diastolic blood pressure. Regarding sleep outcomes, the ALIVE biofeedback group reported increased sleep duration and decreased sleep disturbances, as indicated by the PSQI-J scores. Furthermore, participants in the ALIVE biofeedback group significantly improved their ISI scores. These findings suggest that the ALIVE biofeedback intervention can potentially improve HRV, blood pressure, sleep quality, and insomnia severity in individuals with insomnia. Conclusion: It is concluded from the study results that the ALIVE biofeedback training is a non-invasive and effective treatment for insomnia.

The Changes of the Infra-Slow EEG Fluctuations of the Brain Potentials under Influence of Infra-Low Frequency Neurofeedback

This study presents a comparison of the effect on EEG electrical activity in the range of infraslow frequencies of two methods: infra-low frequency EEG biofeedback and heart rate variability training. The study involved 17 healthy subjects aged 21 to 50 years with minor symptoms of a physiological or psychological nature, who did not have a history of neurological or psychiatric diseases. To evaluate the results of the training, we analyzed the spectral power of slow EEG oscillations during the performance of the attention test (Visual Go/NoGo), recorded before and after twenty sessions of biofeedback. Both the subjective assessment of the physiological and psychological state and the results of the visual test showed more pronounced positive changes under the influence of EEG biofeedback compared to the cases of heart rate variability training. A significant increase in the amplitudes of oscillations in the infraslow EEG range was observed only after EEG biofeedback.

Can HRV Training Make Us Happy: An Experimental Study on University Students

The purpose of this study is to determine the effect of 8 weeks of HRV (Heart Rate Variability) training on the happiness and coherence levels of university students. According to this purpose, 20 sports management students from the same class volunteered to participate in the study. 10 students were selected randomly as the experimental group while the other 10 were control group. Data was collected with Oxford Happiness Inventory and Inner Balance HeartMath (biofeedback device). 8 weeks of HRV training was applied to the experiment group every night before going to sleep. After 8 weeks, the results showed a significant difference between pretest and post-test results p < 0.05. The experimental group increased their happiness and coherence while the control group decreased. In other words, the experimental group is now happier and more coherent.

Эффективность кардиобиоуправления у подростков 15–16 лет после физической нагрузки в условиях низких температур

Short-term biofeedback (BF) training provides effective restoration of the cardiovascular system (CVS) after physical exercise. Purpose: assessment of CVS reactivity in adolescents aged 15–16 years during a heart rate variability (HRV) BF session following a speed-strength exercise (thricerepeated standing long jump) in the open air (from –1 to –10 °C). Materials and methods. Healthy adolescents were examined: an experimental group (n = 15) subject to HRV BF training (3 min) using Varikard equipment (Ramena, Russia) in order to increase the total HRV power and a control group (n = 12). The following stages of recording HRV and blood pressure indicators were singled out: background (initial indicators), period immediately after physical activity, and recovery period with HRV training (experimental group) or being at rest (control group). Results. During the recovery period after a HRV BF session, subjects from the experimental group showed significantly higher total HRV power compared with the control (p = 0.04). In experimental group individuals with a heart rate of less than 90 bpm against the background of its increase during BF training, stress index did not change significantly. In subjects with tachycardia (above 90 bpm), heart rate and stress index remained elevated at all stages. Conclusion. Short-term BF training (3 min) after a speed-strength exercise in a cold environment increases the total HRV power in adolescents; the degree of reduction in sympathetic response depends on the initial heart rate level. The relative increase in heart rate during HRV BF training after physical exercise in a cold environment indicates the need for a longer BF session (over 3 min) in order to achieve a more pronounced influence of vagal effects on the heart rhythm.

Biofeedback-Assisted Relaxation Training: A Clinically Effective Treatment Protocol

Purchasing biofeedback instruments and learning the technical process of operating each biofeedback instrument with a human subject are not enough. These steps are necessary, but they do not clearly guide one as to how the instruments should be used. A treatment protocol is required that provides an explanation of the patient's current suffering or problem, as well as a rationale for using biofeedback training in a fashion that can reasonably be expected to relieve that suffering. Such models or protocols are necessary to organize the process of the biofeedback training and provide a reasonable explanation to motivate the trainee/client. Experience shows that clients who understand how the intervention is relevant for their complaint apply themselves more fully and follow through with any homework more reliably. There are a number of such protocols, including biofeedback-assisted relaxation training, the breath training and respiratory biofeedback model, resonance frequency heart rate variability training, the neuromuscular rehabilitation model, various neurofeedback training models, and psychophysiological psychotherapy. This article will introduce biofeedback-assisted relaxation training (BART). BART is a widely applied biofeedback protocol in clinical practice and has been documented as effective in clinical studies from 1969 to the present, for anxiety disorders, diabetes, headaches, and a variety of other common medical and psychological conditions.

Soccer Matches but Not Training Sessions Disturb Cardiac-Autonomic Regulation During National Soccer Team Training Camps

ABSTRACT Purpose: Heart rate variability (HRV) can be used to monitor changes in autonomic nervous system (ANS) function. Monitoring HRV via the natural log of the root-mean-square difference of successive normal RR intervals (lnRMSSD), a decrease was related to lower parasympathetic activity and a fatigued state, and an increase was related to higher parasympathetic activity and better physical conditioning. This study analyzed daily ANS function changes among professional soccer players at national team training camps during preparation for the UEFA Eurocup 2016. Method: 23 professional soccer players were distributed into two groups: First eleven (players who played more than 60 minutes per soccer match) and Reserves (the rest of the players). HRV and session training load (s-TL) were monitored. Between-group daily differences were assessed using two-way mixed repeated measures ANOVA. Results: s-TL significantly increased (p < .05) at the beginning of each camp and significantly decreased the day before the soccer match (p < .001). There was a significant time by group interaction in lnRMSSD (p = .024). Changes were found in the First eleven group from match day +1 to match day +2 (+0.523 ms, p = .003). After the soccer match, there were between-group differences (p < .05) at +24h and +72h in lnRMSSD. Conclusions: During national team training camps, ANS function was only modified 24h and 72h after playing soccer matches, in players who played a minimum of 60 minutes. This knowledge can help coaches to monitor the impact of soccer matches during training camps to detect fatigue and improve recovery.

Special Issue: Integrating Mindfulness Training with Clinical Biofeedback: Practical Applications

This special issue continues the focus of the spring and summer 2018 issues (Volume 46, Issues 1 and 2) on the benefits of integrating mindfulness and biofeedback approaches and identifies several new areas of application in pediatric biofeedback, the treatment of adults with intellectual disabilities, care for persons with respiratory illness and mechanical ventilation, and the management of chronic multiple sclerosis.The issue opens with an article by two leaders in biofeedback, who argue that mindfulness is as a natural extension of the awareness training inherent in biofeedback and other self-regulation approaches. Eric Peper and Richard Harvey compare mindfulness with other self-regulation strategies, such as progressive muscle relaxation, autogenic training, and transcendental meditation. They identify common elements shared by mindfulness with other self-regulation strategies. They also argue that most of the commonly used self-regulation strategies have comparable efficacy. They suggest mechanisms making many such self-regulation skills effective, including effects on the gamma aminobutyric acid neurotransmitter system. Finally, they call for further research to explore dropout rates, adverse effects, and other dimensions of mindfulness training.Next, Jonathan Sikorski and Olivia Hernandez-Gonzalez address the challenges in applying mindfulness-based interventions with two special populations. They point out that young children often struggle with communicating their needs, feelings, and desires with others. Adults with intellectual disabilities face similar challenges. The authors introduce practical strategies they have developed to introduce mindfulness skills for these two groups. They also use biofeedback as a tool to assist both groups in enhancing internal awareness of the link between emotions and physiological sensations. To illustrate their approach, they present two case narratives, the first a 10-year-old boy with generalized anxiety disorder, and the second a 28-year-old adult with Prader-Willi syndrome and intellectual disabilities.Urszula Klich presents a case study illustrating her clinical approach, which emphasizes teaching self-regulation and compassion. The case example in her article presents a patient with a tracheostomy who is experiencing anxiety related to pain and anxiety about eventual removal of her vent. Mechanical ventilation for acute respiratory insufficiency accounts for approximately 800,000 hospitalizations each year, and discontinuation of mechanical ventilation is challenging for patients and care teams alike. Klich combined compassion-based strategies with biofeedback to reduce anxiety about decannulation (removal of the tracheostomy tube). Her interventions included mindfulness meditation, breath training, heart rate variability training, loving kindness meditation, and the use of mindfulness strategies to ameliorate anxiety.In the final article, Donald Moss discusses the integration of mindfulness training, clinical biofeedback, and lifestyle change in the management of multiple sclerosis (MS). Moss provides a discussion of the medical diagnosis and treatment of MS, a review of the epidemiology and genetics of the condition, and a case narrative describing a 36-year-old woman with a pattern of chronic relapsing MS. This chapter also shows the use of the Pathways Model to organize treatment. The Pathways Model is an overall self-directed program of acquiring self-regulation skills and implementing lifestyle changes as a supplement to professional intervention.

Z-Score Neurofeedback and Heart Rate Variability Training for Adults and Children with Symptoms of Attention-Deficit/Hyperactivity Disorder: A Retrospective Study

ADHD is a common condition that causes suffering for those affected and economic loss for society at large. The current standard treatment for ADHD includes stimulant medications, which are not effective for all patients, may include side effects, and can be non-medically misused. Z-score neurofeedback (NFB) and heart rate variability (HRV) biofeedback are alternative treatment strategies that have been associated with Attention-Deficit/Hyperactivity Disorder (ADHD) symptom improvement. We utilized a retrospective pre-post study design to quantify the change in clients’ ADHD symptoms after combined NFB + HRV treatment (which included simultaneous z-score training at four sites). We also assessed whether relevant physiological measures changed in accordance with the protocol, which would be consistent with effective NFB + HRV training. Adults (n = 39) and children (n = 100) with Borderline or Clinical ADHD classifications by the Achenbach System of Empirically Based Assessment (ASEBA) received 30 sessions of NFB + HRV training. Measures were compared before and after treatment for the ASEBA, the Integrated Visual and Auditory Continuous Performance Test (IVA), ADHD medication use, HRV and breathing parameters, and quantitative electroencephalogram (QEEG) parameters. Average ASEBA Attention-Deficit/Hyperactive Problems score improved after treatment for adults and children (p < 0.0001), with Cohen effect sizes (dz) of −1.21 and −1.17, respectively. 87.2% of adults and 80.0% of children experienced improvements of a magnitude greater than or equal to the Minimal Clinically Important Difference. After treatment, 70.8% of adults and 52.8% of children who began in the ASEBA Clinical range, and 80.0% of adults and 63.8% of children who began in the ASEBA Borderline range, were classified in the Normal range. IVA scores also improved after treatment. Changes in HRV and breathing pattern after treatment were consistent with the protocol. QEEG parameters after treatment were closer to the age-based normative mean, which is consistent with effective z-score NFB training.

Different Clinical Expression of Anxiety Disorders in Children and Adolescents: Assessment and Treatment.

Different Clinical Expression of Anxiety Disorders in Children and Adolescents: Assessment and Treatment.

No Effects of Successful Bidirectional SMR Feedback Training on Objective and Subjective Sleep in Healthy Subjects.

There is a growing interest in the application of psychophysiological signals in more applied settings. Unidirectional sensory motor rhythm-training (SMR) has demonstrated consistent effects on sleep. In this study the main aim was to analyze to what extent participants could gain voluntary control over sleep-related parameters and secondarily to assess possible influences of this training on sleep metrics. Bidirectional training of SMR as well as heart rate variability (HRV) was used to assess the feasibility of training these parameters as possible brain computer interfaces (BCI) signals, and assess effects normally associated with unidirectional SMR training such as the influence on objective and subjective sleep parameters. Participants (n = 26) received between 11 and 21 training sessions during 7 weeks in which they received feedback on their personalized threshold for either SMR or HRV activity, for both up- and down regulation. During a pre- and post-test a sleep log was kept and participants used a wrist actigraph. Participants were asked to take an afternoon nap on the first day at the testing facility. During napping, sleep spindles were assessed as well as self-reported sleep measures of the nap. Although the training demonstrated successful learning to increase and decrease SMR and HRV activity, no effects were found of bidirectional training on sleep spindles, actigraphy, sleep diaries, and self-reported sleep quality. As such it is concluded that bidirectional SMR and HRV training can be safely used as a BCI and participants were able to improve their control over physiological signals with bidirectional training, whereas the application of bidirectional SMR and HRV training did not lead to significant changes of sleep quality in this healthy population.

Erratum to: Combined Neurofeedback and Heart Rate Variability Training for Individuals with Symptoms of Anxiety and Depression: A Retrospective Study

Erratum to: Combined Neurofeedback and Heart Rate Variability Training for Individuals with Symptoms of Anxiety and Depression: A Retrospective Study

Combined Neurofeedback and Heart Rate Variability Training for Individuals with Symptoms of Anxiety and Depression: A Retrospective Study

The original published version of this manuscript included a typo on page 43, in the ‘Statistical Analysis’ subsection of the Methods. The original text read: “All p -values were assessed using an experiment-wise error rate of α = 0.05 adjusted for multiple testing and comparisons with Bonferroni correction. With 19 comparisons, the Bonferroni corrected significance level was α B = 0 .” The “ 0 ” was a typographical error. The Bonferroni corrected significance level for the study is 0.05/19, α B = 0.0026 , and the Methods section text has now been corrected to reflect this. The text now reads: “All p -values were assessed using an experiment-wise error rate of α = 0.05 adjusted for multiple testing and comparisons with Bonferroni correction. With 19 comparisons, the Bonferroni corrected significance level was α B = 0.0026 .” The authors regret any confusion that this error may have caused.

Current Practice of Neurofeedback: Where We Are and How We Got There

This article tracks the evolution of the practice of neurofeedback over the past quarter century from the perspective of services offered at a private clinic. It describes why and how the authors changed their practices from interventions including medication, psychotherapy, and tutoring to biofeedback interventions. Their evolving practices required complex assessments including single- and two-channel quantitative electroencephalograph (QEEG) and later 19-channel QEEG combined with evoked potentials, heart rate variability, continuous performance testing, and neuropsychological assessment. The article stresses that interventions require a multimodal approach. The neuroanatomical rationale for combining neurofeedback and heart rate variability (HRV) training is provided as well as a discussion of how a systems theory of neural synergy helps explain how neurofeedback influences brain networks. Assessment procedures are described in some detail because that information is used to develop effective interventions that typically combine neurofeedback (single-channel or LORETA Z-score neurofeedback, as indicated) with HRV training. The authors stress using evidence-based approaches, basing intervention on assessment, and keeping current with new developments in applied neuroscience.

HRV4Training: Large-scale longitudinal training load analysis in unconstrained free-living settings using a smartphone application.

We describe an approach to support athletes at various fitness levels in their training load analysis using heart rate (HR) and heart rate variability (HRV). A smartphone-based application (HRV4Training) was developed that captures heart activity over one to five minutes using photoplethysmography (PPG) and derives HR and HRV features. HRV4Training integrated a guide for an early morning spot measurement protocol and a questionnaire to capture self-reported training activity. The smartphone application was made publicly available for interested users to quantify training effect. Here we analyze data acquired over a period of 3 weeks to 5 months, including 797 users, breaking down results by gender and age group. Our results suggest a strong relation between HR, HRV and self-reported training load independent of gender and age group. HRV changes due to training were larger than those of HR. We conclude that smartphone-based training monitoring is feasible and a can be used as a practical tool to support large populations outside controlled laboratory environments.

The Use of Heart Rate Variability Biofeedback and Neurofeedback for Traumatic Brain Injury

The Use of Heart Rate Variability Biofeedback and Neurofeedback for Traumatic Brain Injury

Cardiac parasympathetic activity and race performance: an elite triathlete case study.

The authors examined whether changes in heart-rate (HR) variability (HRV) could consistently track adaptation to training and race performance during a 32-wk competitive season. An elite male long-course triathlete recorded resting HR (RHR) each morning, and vagal-related indices of HRV (natural logarithm of the square root of mean squared differences of successive R-R intervals [ln rMSSD] and the ratio of ln rMSSD to R-R interval length [ln rMSSD:RR]) were assessed. Daily training load was quantified using a power meter and wrist-top GPS device. Trends in HRV indices and training load were examined by calculating standardized differences (ES). The following trends in week-to-week changes were consistently observed: (1) When the triathlete was coping with a training block, RHR decreased (ES -0.38 [90% confidence limits -0.05;-0.72]) and ln rMSSD increased (+0.36 [0.71;0.00]). (2) When the triathlete was not coping, RHR increased (+0.65 [1.29;0.00]) and ln rMSSD decreased (-0.60 [0.00;-1.20]). (3) Optimal competition performance was associated with moderate decreases in ln rMSSD (-0.86 [-0.76;-0.95]) and ln rMSSD:RR (-0.90 [-0.60;-1.20]) in the week before competition. (4) Suboptimal competition performance was associated with small decreases in ln rMSSD (-0.25 [-0.76;-0.95]) and trivial changes in ln rMSSD:RR (-0.04 [0.50;-0.57]) in the week before competition. To conclude, in this triathlete, a decrease in RHR concurrent with increased ln rMSSD compared with the previous week consistently appears indicative of positive training adaptation during a training block. A simultaneous reduction in ln rMSSD and ln rMSSD:RR during the final week preceding competition appears consistently indicative of optimal performance.

From the Editor

The cover of this issue of Biofeedback shows a neurofeedback session at the University of North Texas (UNT) in Denton. The photo was chosen for two reasons. The session illustrates the case described by Cara Guziak and Julia Smith in an article on anxiety misdiagnosed as dementia. The photo also serves as a tribute to Dr. Eugenia Bodenheimer-Davis, who has skillfully guided so many students into the field of neurofeedback. Dr. Bodenheimer-Davis has now retired, and her UNT lab, where Guziak and Smith conducted their research, is closing. Both Genie and the lab have contributed decades of service to the field of biofeedback.Cynthia Kerson, a Board member of the International Society for Neurofeedback and Research (ISNR) Research Foundation, begins a two-part series in this issue about the foundations that support research and education in biofeedback and neurofeedback. In this first article, she interviews David Trudeau, the president of the ISNR Foundation. In the interview, Trudeau describes trends in current research in neurofeedback, the challenges in obtaining funding for neurofeedback research, and the role of the ISNR Research Foundation.Judy Crawford and Fred Shaffer provide an update on the Biofeedback Certification International Alliance (BCIA). They quote a line from a Bob Dylan song, “He not busy being born is busy dying.” BCIA is busy growing and renewing itself through growth of an international BCIA affiliate in Australia, increases in international certifications, and streamlined certification and recertification requirements worldwide.Cara Guziak and Julia Smith provide a case study of “J. C.,” a 63-year-old woman referred with a diagnosis of dementia after difficulties locating her new office building. The authors describe a thorough assessment including psychometric testing as well as a Test of Variable Attention (TOVA) and a quantitative electroencephalogram (QEEG). The assessment documented measurable anxiety, depression, hopelessness, sleep disturbance, and impulsivity, as well as a QEEG pattern typical of persons with heightened anxiety but with additional markers possibly reflective of dementia and/or medication effects. Their intervention included counseling, training in diaphragmatic breathing, heart rate variability training, and neurofeedback. J. C. improved with treatment, showing improved cognitive function, enhanced sleep, and improved scores on anxiety, depression, and hopelessness. Both the TOVA and the QEEG showed normalization. This case study shows the positive role for biofeedback and neurofeedback for some patients with apparent dementia.Erik Peper, Annette Booiman, I-Mei Lin, and Fredric Shaffer provide an article on the use of surface electromyography biofeedback to teach muscle awareness and reduce chronic muscle contraction. The authors observe that poor awareness of low-level muscle tension and poor ergonomics contribute to muscle bracing and the development of musculoskeletal symptoms, including pain. They describe a research study with a sample of 34 physical therapists, which conducted an initial assessment of muscle awareness and then utilized visual feedback of muscle activity to train muscle awareness and control. The participants, who were physical therapists educated in muscle kinesiology, were surprised at the extent of their muscle awareness on the initial task. The article closed with a brief case study showing the usefulness of muscle awareness training in a woman with severe pelvic girdle pain.Rafal Stzembis, a cardiologist in Poland, and Donald Moss contribute an article showing the role of biofeedback in the clinical practice of cardiology. Increasing attention is being given to psychological factors, including depression, anxiety, and stress, as important factors that influence progression of heart disease. Sztembis conducted a study in a Polish hospital-based cardiology unit, utilizing a Psychophysiological Stress Profile to assess patients after myocardial infarction. The researchers identified patients who could implement diaphragmatic breathing practice at home and others who required more extensive biofeedback training. The authors call for further research to document improved medical and psychological outcomes using this model.Elizabeth Bigham, Lauren McDannel, Isabel Luciano, and Guadalupe Salgado-Lopez contribute an article reporting a study measuring the impact of a guided imagery intervention on perceived stress. The researchers studied 29 participants and administered a symptom checklist and a biofeedback assessment of heart rate and heart rate variability coherence levels before and after an intervention. Their intervention consisted of a guided imagery script of a beach scene. Their postintervention assessment documented significant reductions in emotional symptoms and in heart rate and a correlation between symptom reduction and heart rate reduction.Daniel Rapport provides a review of a new book by Angele McGrady and Donald Moss, Pathways to Illness, Pathways to Health (Springer, 2013). The book provides a stepwise program for integrating self-directed life style and health behavior changes and the acquisition of self-regulation skills, with professional treatment interventions to address a wide variety of medical and emotional disorders. Each chapter is illustrated with a case study applying the Pathways approach to treatment of a specific disorder. Rapport recommends the Pathways book for beginners and experienced clinicians alike.

Evaluation of heart rhythm coherence feedback training on physiological and psychological variables

HeartMath refers to a psychophysiological approach dedicated to helping people establish heart-based living and global coherence through heart rate variability training, especially through heart rhythm coherence feedback. This study investigated the influence of emWave2 heart rhythm coherence feedback learning on standardized measures of physiological coherence, sense of coherence, health, mindfulness, and spirituality perceptions, as experienced and evaluated by a small convenience sample of 10 participants. Six women and four men with a mean age of 44.8 years and an age range from 23 to 78 years completed at least five emWave2 biofeedback sessions, with a mean of 10 sessions and a range from 5 to 15 sessions. Quantitative findings indicated significant improvements on all standardized measures. Qualitative findings indicated meaningful experiences and positive evaluations of the workshop. Integrative findings are discussed in relation to previous and future research.

Treating Postconcussion Syndrome Using Neurofeedback: A Case Study

The present article provides a case study showing the application of neurofeedback and biofeedback training with heart rate variability (HRV) training to a 27-year-old man, Mike, who suffered a severe traumatic brain injury (TBI) in a motor vehicle accident. The study demonstrates the use of single-site neurofeedback training, metacognitive strategies, and low-resolution brain electromagnetic tomography (LORETA) z-score training along with HRV. A review of the initial assessment and subsequent progress updates included an examination of continuous performance tests such as test of variables of attention, integrated visual and auditory continuous performance test, and single-channel electroencephalography results, HRV statistics, and 19-channel quantitative electroencephalogram results. The client demonstrated significant improvements on all measures posttraining with marked improvement in five areas: memory, sleep and energy level, academics, mood and irritability, and mental sharpness. Working with clients such as Mike supports the view that one- and two-channel neurofeedback and LORETA z-score neurofeedback, combined with HRV training, are promising interventions for clients with TBIs.

Managing Traumatic Brain Injury: Appropriate Assessment and a Rationale for Using Neurofeedback and Biofeedback to Enhance Recovery in Postconcussion Syndrome

Impairments that may result from a mild traumatic brain injury (TBI) or concussion can be both severe and long-lasting. This article will list some of the common persisting symptoms that may occur and give a brief description of the neuropathological processes that can be triggered by TBI, including diffuse axonal injury and its effects on the mitochondrial Kreb's cycle and the production of adenosine triphosphate, the brain's source of energy. This is followed by a summary of a comprehensive assessment process that includes quantitative electroencephalography, evoked potentials, heart rate variability (HRV) measures, neuropsychological testing, and blood and urine analysis. Details concerning a neurophysiological approach to effective treatment are given. These include conventional single-channel neurofeedback (NFB), also called brain-computer interface training, low-resolution electromagnetic tomography z-score neurofeedback, HRV training, and counseling on diet, sleep, and exercise. The authors expand the discussion on their treatment approach to include a neuroanatomical explanation of why the practitioner should consider combining the NFB training with HRV training.